Now with 2 locations
to better serve our
customers.
 		  Store Hours 
Monday thru Friday
 8:30am to 5:30pm
Saturday
9am to 1pm
131 East Main Street 
Orange, Virginia 22960
Phone (540) 672-0607   Fax (540) 672-1058		 750 Old Brandy Road 
Culpeper, Virginia 22701
Phone (540) 727-9700   Fax (540) 727-9790
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"SERVICE & COMPETITIVE PRICES ARE OUR WAY OF DOING BUSINESS"

Application for Credit

Company Information

Name : Year Incorporated :

Mailing Address : Years in Business :

City : State : Zip Code :

Email Address:

Phone : Fax :

Shipping Address :

City : State : Zip Code :

Departments :

Type of Business :

Bank Account Information

Bank : Address :

Phone :

Type : Account # : Officer :

Business References

Name : Address :

Phone :

Name : Address :

Phone :

Name : Address :

Phone :

Our credit term is net 30 days.

We certify that all the information on this for is correct. We fully understand your credit terms and agree to the proper payment in consideration of extended credit.

Date :

Signature : Title :

You can print this application and fax / mail it or click "Submit" to email it.